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Hasegawa S, Nakagawa Y, Yoshihara A, Nakamura T, Katagiri H, Hayashi M, Yoshimura H, Nagase T, Sekiya I, Koga H. Older Age, Poor Preoperative Quadriceps Muscle Strength, and Residual Pain as Risk Factors for Poor Quadriceps Muscle Strength Recovery at 1 Year After ACL Reconstruction: A TMDU MAKS Study of 402 Patients. Orthop J Sports Med 2023; 11:23259671231194593. [PMID: 37693805 PMCID: PMC10492478 DOI: 10.1177/23259671231194593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/04/2023] [Indexed: 09/12/2023] Open
Abstract
Background Poor postoperative quadriceps muscle strength recovery after anterior cruciate ligament reconstruction (ACLR) leads to delayed return to sports and lower patient satisfaction. Purpose/Hypothesis The purpose of this study was to examine factors that affect quadriceps muscle strength 1 year after ACLR. It was hypothesized that older age, poor preoperative quadriceps muscle strength, and residual pain would be risk factors for poor quadriceps muscle strength recovery. Study Design Case-control study; Level of evidence, 3. Methods Included were patients from multiple institutions who underwent primary ACLR using autologous hamstring tendon grafts between August 1, 2013, and March 31, 2018, and who had at least 1 year of follow-up data. Patients with past ligamentous injuries in the affected knee, previous injuries or operations in the contralateral knee, accompanying ligament injuries of grade 2 or 3, or inflammatory or other types of osteoarthritis were excluded. Patients were categorized as having muscle strength ≥80% (good strength recovery) or <80% (poor strength recovery) compared with the contralateral leg at 1 year postoperatively. Multivariate logistic regression analysis was performed to investigate the factors influencing postoperative quadriceps muscle strength. In addition, a categorical analysis was conducted based on factors extracted by the multivariate logistic regression analysis. Results A total of 402 patients were included. Multivariate logistic regression analysis revealed that age at surgery (P = .020), preoperative quadriceps muscle strength (P = .006), and postoperative Knee injury and Osteoarthritis Outcome Score (KOOS)-Pain score (P = .002) were significantly associated with quadriceps muscle strength at 1 year postoperatively. The odds of poor muscle strength recovery according to categorical analysis were 5.0-fold higher for patients aged >40 versus ≤20 years, 4.2-fold higher for those with preoperative quadriceps muscle index <60% versus ≥80%, and 7.7-fold higher for those with a postoperative KOOS-Pain score of <85 versus 100. Conclusion Older age, poor preoperative quadriceps muscle strength, and low postoperative KOOS-Pain score were risk factors for poor quadriceps muscle strength 1 year after primary ACLR. Surgical indications, including age, preoperative active rehabilitation, and pain control, should be considered for optimization of postoperative quadriceps muscle strength recovery.
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Affiliation(s)
- Shoichi Hasegawa
- Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yusuke Nakagawa
- Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Aritoshi Yoshihara
- Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Tomomasa Nakamura
- Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Hiroki Katagiri
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Masaya Hayashi
- Department of Orthopaedic Surgery, Kawaguchi Kogyo General Hospital, Kawaguchi, Saitama, Japan
| | - Hideya Yoshimura
- Department of Orthopaedic Surgery, Kawaguchi Kogyo General Hospital, Kawaguchi, Saitama, Japan
| | - Tsuyoshi Nagase
- Department of Orthopaedic Surgery, Doai Memorial Hospital, Tokyo, Japan
| | - Ichiro Sekiya
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan
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Hunnicutt JL, Xerogeanes JW, Tsai LC, Sprague PA, Newsome M, Slone HS, Lyle MA. Terminal knee extension deficit and female sex predict poorer quadriceps strength following ACL reconstruction using all-soft tissue quadriceps tendon autografts. Knee Surg Sports Traumatol Arthrosc 2021; 29:3085-3095. [PMID: 33175281 DOI: 10.1007/s00167-020-06351-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The all-soft tissue quadriceps tendon (QT) autograft is becoming increasingly popular for ACL reconstruction (ACLR); however, studies reporting strength recovery and early outcomes after QT autograft are limited with patient samples composed of predominantly males. The primary purpose was to characterize early, sex-specific recovery of strength, range of motion (ROM), and knee laxity in a large cohort of patients undergoing primary ACLR with standardized harvest technique of the all-soft tissue QT autograft. The secondary purpose was to examine the influence of demographic factors and clinical measures on 6-month quadriceps strength. METHODS Patients 14-25 years who underwent primary, unilateral ACLR with all-soft tissue QT autografts were prospectively followed. Knee laxity and ROM were collected at 6 weeks, 3 and 6 months; while, quadriceps normalized torques and limb symmetry indices (LSI) were collected at 3 and 6 months using isokinetic dynamometry at 60°/s. Two-way ANOVAs with repeated measures were conducted to determine recovery over time and between sexes. Stepwise linear multiple regressions were conducted to determine predictors of 6-month quadriceps strength. RESULTS Three-hundred and twenty patients were included (18 ± 3 years; 156 males:164 females; BMI = 24 ± 4 kg/m2) with no early graft failures within the study period. For strength, there were significant main effects of time (p < 0.001) and sex (p < 0.001), indicating similar improvement from 3 to 6 months with males demonstrating greater quadriceps LSI (6 months: 72.1 vs 63.3%) and normalized strength (6 months: 2.0 vs 1.6 Nm/kg). A significantly higher proportion of females had knee extension ROM deficits ≥ 5° compared to males at 6 weeks (61 vs 39%; p = 0.002). Female sex and 3-month extension ROM deficits were identified as significant predictors of 6-month quadriceps LSI (R2 = 0.083; p < 0.001). Female sex, BMI, and 6-week extension ROM deficits were identified as significant predictors of 6-month normalized quadriceps strength (R2 = 0.190; p < 0.001). CONCLUSIONS Females had decreased quadriceps strength and greater extension ROM deficits at 3 and 6 months following ACLR using all-soft tissue QT autografts. Female sex, higher BMI, and loss of extension ROM were independent predictors of poorer quadriceps strength at 6 months. There were no early graft failures, and laxity remained within normal ranges for both males and females. Surgeons and rehabilitation clinicians should be aware of the increased risk of postoperative loss of extension ROM in females and its implications on quadriceps strength recovery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jennifer L Hunnicutt
- Department of Orthopaedics, School of Medicine, Emory University, 1968 Hawks Lane, Atlanta, GA, 30329, USA.
| | - John W Xerogeanes
- Department of Orthopaedics, School of Medicine, Emory University, 1968 Hawks Lane, Atlanta, GA, 30329, USA.,Emory Orthopaedics and Spine Center, Emory Healthcare, Atlanta, USA
| | - Liang-Ching Tsai
- Department of Physical Therapy, College of Nursing and Health Professions, Georgia State University, Atlanta, USA
| | - Peter A Sprague
- Division of Physical Therapy, School of Medicine, Emory University, Atlanta, USA
| | - Michael Newsome
- Emory Orthopaedics and Spine Center, Emory Healthcare, Atlanta, USA
| | - Harris S Slone
- Department of Orthopaedics, College of Medicine, Medical University of South Carolina, Charleston, USA
| | - Mark A Lyle
- Division of Physical Therapy, School of Medicine, Emory University, Atlanta, USA
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Iwame T, Matsuura T, Okahisa T, Katsuura-Kamano S, Wada K, Iwase J, Sairyo K. Quadriceps strength to body weight ratio is a significant indicator for initiating jogging after anterior cruciate ligament reconstruction. Knee 2021; 28:240-246. [PMID: 33429149 DOI: 10.1016/j.knee.2020.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/25/2020] [Accepted: 12/18/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Quadriceps strength recovery after anterior cruciate ligament (ACL) reconstruction is an important criterion for progress in rehabilitation and return to sports. The purpose of this study was to determine whether quadriceps strength to body weight ratio (QS/BW) is a significant indicator for initiating jogging after ACL reconstruction. METHODS Isokinetic quadriceps strength at 60°/s was measured and a jogging trial was completed 3 months after ACL reconstruction with hamstring tendon autograft in 83 patients (36 male, 47 female; mean age, 26.6 ± 12.4 years). Based on the jogging trial results, patients were assigned to either a successful jogging group (mean velocity ≥ 9 km/h) or an unsuccessful jogging group (mean velocity < 9 km/h). The association between QS/BW and successful jogging after surgery was investigated by multivariate logistic regression analysis and the cut-off value was determined by receiver operating characteristic analysis. RESULTS Forty-four patients (53.0%) were assigned to the successful jogging group and 39 (47.0%) to the unsuccessful jogging group. QS/BW was independently associated with initiating jogging 3 months after surgery. The cut-off value of QS/BW for successful jogging was 1.45 Nm/kg (area under the curve = 0.94; sensitivity = 88.6%, specificity = 87.2%). All of the patients who initiated jogging with QS/BW of > 1.45 Nm/kg at 3 months returned to sports without recurrence or contralateral injury by 10 months after surgery. CONCLUSIONS QS/BW is a significant indicator for safely initiating jogging 3 months after ACL reconstruction. The cut-off value of QS/BW for initiating jogging was 1.45 Nm/kg.
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Affiliation(s)
- T Iwame
- Department of Orthopedics, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.
| | - T Matsuura
- Department of Orthopedics, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - T Okahisa
- Department of Rehabilitation, Tokushima University Hospital, Tokushima, Japan
| | - S Katsuura-Kamano
- Department of Preventive Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - K Wada
- Department of Orthopedics, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - J Iwase
- Department of Orthopedics, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - K Sairyo
- Department of Orthopedics, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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